Overcoming Oversedation in Hospitalized Patients: More Than Meets the Eye

Purpose:
This session highlights one organization that significantly decreased opioid-induced oversedation in hospitalized patients using multiple strategies such as diligent case review to determine root cause, enhanced nurse monitoring, education, and prescribing alerts.

Significance:
Opioids are commonly employed in hospitalized patients to manage acute, chronic, and malignant pain. While safe for most patients, opioids can lead to oversedation, respiratory depression, and even death.

Strategy and Implementation:
A nurse-led, interdisciplinary oversedation committee convened to review oversedation reports and to determine the root cause of each incident. Opioid oversedation was defined as response to naloxone that resulted in alertness. A research study emerged to identify predictors of opioid-induced oversedation in hospitalized patients. Trends were analyzed and reported to nursing and physician council. A multitude of strategies were employed to address trends in oversedation, for example: 1) Alert to pharmacy plus provider education with intravenous hydromorphone dosing > 1 mg, 2) Electronic alert with morphine orders in patients with a reduced creatinine clearance, 3) Use of capnography monitoring, 4) Real time review of oversedation cases, 5) Implementation of a program to address perioperative patients at risk for sleep apnea, and 6) Education at physician and nursing grand rounds detailing specific case studies in which oversedation occurred.

Evaluation:
Oversedation rates, calculated per 1000 patient days, decreased from 2.91 to 0.66. Rates have been maintained at < 1 over the past year.

Implications for Practice:
Vigilant analysis of oversedation cases with strategies focused on the common root causes can decrease rates and improve patient safety. Lessons learned can contribute to generalizable knowledge and promote evidence-based practice.